Gemcitabine for colon and rectal cancer
Gemcitabine has not traditionally been used for colon and rectal cancer, but more recently, as patients are living longer and exhausting available chemotherapy options, there has a been a resurgence of interest in this drug as a salvage option. A recent study enrolled twenty two patients. The majority of the patients (17/22) had performance status (PS) ECOG 0-1 and the remaining patients (5/22) had PS 2 at the time of initiation of the gemcitabine-based regimen. Thirteen patients demonstrated a clinical benefit (2 partial response, 2 minor response, 9 stable disease), 6 patients progressed and 2 were not evaluable. The authors concluded that gemcitabine has a modest activity in heavily pre-treated colorectal cancer patients and may be an option in good performance status patients. More work remains to be done. A 2009 review of this topic concluded that Fluoropyrimidine plus gemcitabine is clinically active in patients with refractory CRC demonstrating prolonged median time to progression and acceptable toxicity only when bolus 5-FU was not used. Whether the effect is due to the gemcitabine component, or the combination is, therefore, not known. There are no phase III studies supporting gemcitabine alone for palliation of multiply treatment colorectal cancer. It may find a role as an enchancer of floropyrinidines in combination and there are several ongoing studies to test this hypothesis.
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